Provider Demographics
NPI:1164569299
Name:BURNS, TROY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S SANTA CLAUS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7704
Mailing Address - Country:US
Mailing Address - Phone:907-490-4650
Mailing Address - Fax:907-490-4653
Practice Address - Street 1:203 S SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7704
Practice Address - Country:US
Practice Address - Phone:907-490-4650
Practice Address - Fax:907-490-4653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA8531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice